Health effects of tobacco

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Smoking can damage many parts of the body

The health effects of tobacco are the effects that use of tobacco has on human health, and
concern about health effects of tobacco has a long history. Research has focused primarily on
cigarette tobacco smoking.[1][2] In 1950, Richard Dollpublished research in the British Medical
Journal showing a close link between smoking and lung cancer.[3] Four years later, in 1954,
the British Doctors Study, a study of some 40,000 doctors over 20 years, confirmed the suggestion,
based on which the government issued advice that smoking and lung cancer rates were related. [4][5]
Tobacco use is the single greatest cause of preventable death globally.[6] As many as half of people
who use tobacco die from the results of this use.[7] The World Health Organization (WHO) estimates
that each year tobacco causes about 6 million deaths (about 10% of all deaths) with 0.6 million of
these occurring in non smokers due to second hand smoke.[7][8] In the 20th century tobacco is
estimated to have caused 100 million deaths.[7] Similarly, the United States Centers for Disease
Control and Prevention describes tobacco use as "the single most important preventable risk to
human health in developed countries and an important cause of premature death worldwide." [9]
Tobacco use leads most commonly to diseases affecting the heart, liver and lungs. Smoking is a
major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD)
(including emphysema and chronic bronchitis), and cancer(particularly lung cancer, cancers of the
larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease
and hypertension. The effects depend on the number of years that a person smokes and on how
much the person smokes. Starting smoking earlier in life and smoking cigarettes higher
in tar increases the risk of these diseases. Also, environmental tobacco smoke, or secondhand
smoke, has been shown to cause adverse health effects in people of all ages. [10] Tobacco use is a
significant factor in miscarriages among pregnant smokers, and it contributes to a number of other
health problems of the fetus such aspremature birth, low birth weight, and increases by 1.4 to 3
times the chance of sudden infant death syndrome (SIDS).[11] Incidence of erectile dysfunction is
approximately 85 percent higher in male smokers compared to non-smokers.[12][13]
Several countries have taken measures to control the consumption of tobacco with usage and sales
restrictions as well as warning messages printed on packaging. Additionally smoke free laws are
useful, do not have negative economic effects for restaurants or bars and help people who smoke to

quit.[7] Taxing tobacco products in an effort to increase the price is also effective, especially in
developing countries.[7] Tobacco smoke contains more than fifty chemicals that cause cancer.
[7]
Tobacco also contains nicotine, which is a highly addictive psychoactive drug. When tobacco is
smoked, nicotine causes physical and psychological dependency. Cigarettes sold in underdeveloped
countries tend to have higher tar content, and are less likely to be filtered, potentially increasing
vulnerability to tobacco smoking related disease in these regions.[14]

Prevention[edit]
Education and counselling by physicians of children and adolescents has been found to be
effective in decreasing the risk of tobacco use. [207]

Usage[edit]

Percentage of females smoking any tobacco product

Percentage of males smoking any tobacco product. Note that there is a difference between the
scales used for females and the scales used for males.[6]

Though tobacco may be consumed by either smoking or other smokeless methods such as
chewing, the World Health Organization(WHO) only collects data on smoked tobacco.
[1]

Smoking has therefore been studied more extensively than any other form of tobacco

consumption.[2]
In 2000, smoking was practiced by 1.22 billion people, predicted to rise to 1.45 billion
people in 2010 and 1.5 to 1.9 billion by 2025. If prevalence had decreased by 2% a year
since 2000 this figure would have been 1.3 billion in 2010 and 2025. [208] Despite dropping by

0.4 percent from 2009 to 2010, the United States still reports an average of 17.9 percent
usage.[33]
As of 2002, about twenty percent of young teens (1315) smoke worldwide, with 80,000 to
100,000 children taking up the addiction every dayroughly half of whom live in Asia. Half
of those who begin smoking in adolescent years are projected to go on to smoke for 15 to
20 years.[209]
The WHO states that "Much of the disease burden and premature mortality attributable to
tobacco use disproportionately affect the poor". Of the 1.22 billion smokers, 1 billion of them
live in developing or transitional nations. Rates of smoking have leveled off or declined in
the developed world.[210] In the developing world, however, tobacco consumption is rising by
3.4% per year as of 2002.[209]
The WHO in 2004 projected 58.8 million deaths to occur globally,[211]:8 from which 5.4 million
are tobacco-attributed,[211]:23 and 4.9 million as of 2007.[212] As of 2002, 70% of the deaths are
in developing countries.[212]
The shift in prevalence of tobacco smoking to a younger demographic, mainly in the
developing world, can be attributed to several factors. The tobacco industry spends up to
$12.5 billion annually on advertising, which is increasingly geared towards adolescents in
the developing world because they are a very vulnerable audience for the marketing
campaigns. Adolescents have more difficulty understanding the long term health risks that
are associated with smoking and are also more easily influenced by "images of romance,
success, sophistication, popularity, and adventure which advertising suggests they could
achieve through the consumption of cigarettes". This shift in marketing towards adolescents
and even children in the tobacco industry is debilitating to organizations and countries
efforts to improve child health and mortality in the developing world. It reverses or halts the
effects of the work that has been done to improve health care in these countries, and
although smoking is deemed as a "voluntary" health risk, the marketing of tobacco towards
very impressionable adolescents in the developing world makes it less of a voluntary action
and more of an inevitable shift.[14]
Many government regulations have been passed to protect citizens from harm caused by
public environmental tobacco smoke. The "Pro-Children Act of 2001" prohibits smoking

within any facility that provides health care, day care, library services, or elementary and
secondary education to children in the USA.[213] On May 23, 2011, New York City enforced a
smoking ban for all parks, beaches, and pedestrian malls in an attempt to eliminate threats
posed to civilians by environmental tobacco smoke. [214]

Studies[edit]
In the 1930s German scientists showed that cigarette smoking caused lung cancer. [220]:15 In
1938 a study by a Johns Hopkins University scientist suggested a strongly negative
correlation between smoking and lifespan. In 1950 five studies were published in which
"smoking was powerfully implicated in the causation of lung cancer". [221] These included the
now classic paper "Smoking and Carcinoma of the Lung" which appeared in the British
Medical Journal. This paper reported that "heavy smokers were fifty times as likely as nonsmokers to contract lung cancer".[3][221]
In 1953, scientists at the Sloan-Kettering Institute in New York City demonstrated that
cigarette tar painted on the skin of mice caused fatal cancers. [220] This work attracted much
media attention; the New York Times and Life both covered the issue. The Reader's
Digest published an article entitled "Cancer by the Carton". [220]:14
A team of British scientists headed by Richard Doll carried out a longitudinal study of 34,439
medical specialists from 1951 to 2001, generally called the "British Doctors Study."[5]The
study demonstrated that about half of the persistent cigarette smokers born in 19001909
were eventually killed by their addiction (calculated from the logarithms of the probabilities
of surviving from 3570, 7080, and 8090) and about two thirds of the persistent cigarette
smokers born in the 1920s would eventually be killed by their addiction.
The health effects of smoking have been significant for the development of the science
of epidemiology. As the mechanism of carcinogenicity is radiomimetic or radiological, the
effects are stochastic. Definite statements can be made only on the relative increased or
decreased probabilities of contracting a given disease. For a particular individual, it is
impossible to definitively prove a direct causal link between exposure to a radiomimetic
poison such as tobacco smoke and the cancer that follows; such statements can only be

made at the aggregate population level. Tobacco companies have capitalized on this
philosophical objection and exploited the doubts of clinicians, who consider only individual
cases, on the causal link in the stochastic expression of the toxicity as actual disease. [222]
There have been multiple court cases on the issue that tobacco companies have
researched the health effects of tobacco, but suppressed the findings or formatted them to
imply lessened or no hazard.[222]
The term "smoker" is given to a person who habitually smokes tobacco on a daily basis.
This category has been the focus of the vast majority of tobacco studies. However, the
health effects of less-than-daily smoking are far less well understood. Studies have often
taken the data of "occasional smokers" (those who have never smoked daily) and grouped
them with those who have never smoked.[223] A 2006 European study on occasional smoking
published findings that the risk of the major smoking-related cancers for occasional smokers
was 1.24 times that of those who have never smoked at all but the result was not
statistically significant. (For a confidence interval of 95%, this data showed an incidence
rate ratio of 0.80 to 1.94.)[223] (Data reduction used Cox proportional hazard model, stratified
by gender and country.) This compares to studies showing that habitual heavy smokers
have greater than 50 times the incidence of smoking-related cancers.
After a ban on smoking in all enclosed public places was introduced in Scotland in March
2006, there was a 17 percent reduction in hospital admissions for acute coronary syndrome.
67% of the decrease occurred in non-smokers. [224]
A study published in the journal Pediatrics refers to the danger posed by what the authors
call "third-hand smoke" toxic substances that remain in areas where smoking has
recently occurred.[225]

History[edit]
Concern about health effects of tobacco has a long history. Gideon Lincecum, an American
naturalist and practitioner of botanical medicine, wrote in the early 19th century on tobacco:
"This poisonous plant has been used a great deal as a medicine by the old school faculty,

and thousands have been slain by it. ... It is a very dangerous article, and use it as you will,
it always diminishes the vital energies in exact proportion to the quantity used - it may be
slowly, but it is very sure."[215]
The late-19th century invention of automated cigarette-making machinery in the American
South made possible mass production of cigarettes at low cost, and cigarettes became
elegant and fashionable among society men as the Victorian era gave way to the
Edwardian. In 1912, American Dr. Isaac Adler was the first to strongly suggest that
lung cancer is related to smoking.[216] In 1924, economist Irving Fisher wrote an antismoking article for the Readers Digest, which said "... tobacco lowers the whole tone of the
body and decreases its vital power and resistance ... tobacco acts like a narcotic poison,
like opium and like alcohol, though usually in a less degree". [217] In 1929, Fritz
Lickint of Dresden,Germany, published a formal statistical evidence of a lung cancertobacco link, based on a study showing that lung cancer sufferers were likely to be
smokers.[218] Lickint also argued that tobacco use was the best way to explain the fact that
lung cancer struck men four or five times more often than women (since women smoked
much less).[218]
Prior to World War I, lung cancer was considered to be a rare disease, which most
physicians would never see during their career.[20][219] With the postwar rise in popularity of
cigarette smoking, however, came an epidemic of lung cancer.
In 1950, Richard Doll published research in the British Medical Journal showing a close link
between smoking and lung cancer.[3] Four years later, in 1954, the British Doctors Study, a
study of some 40,000 doctors over 20 years, confirmed the suggestion, based on which the
government issued advice that smoking and lung cancer rates were related. [4]The British
Doctors Study lasted until 2001, with results published every ten years and final results
published in 2004 by Doll and Richard Peto.[5] Much early research was also done by Alton
Ochsner. Reader's Digest magazine for many years published frequent anti-smoking
articles. On January 11, 1964, the United States Surgeon General's Report on Smoking and
Health was published; this led millions of American smokers to quit, the banning of certain
advertising, and the requirement of warning labels on tobacco products.